, Volume 6, Issue 3, pp 475–482 | Cite as

A Preliminary Study: Efficacy of Mindfulness-Based Cognitive Therapy versus Sertraline as First-line Treatments for Major Depressive Disorder

  • Stuart J. EisendrathEmail author
  • Erin Gillung
  • Kevin Delucchi
  • Daniel H. Mathalon
  • Tony T. Yang
  • Derek D. Satre
  • Rebecca Rosser
  • Walter E. B. Sipe
  • Owen M. Wolkowitz


Major depressive disorder (MDD) is the leading cause of disability in the developed world, yet broadly effective treatments remain elusive. The primary aim of this pilot study was to investigate the efficacy of mindfulness-based cognitive therapy (MBCT) monotherapy, compared to sertraline monotherapy, for patients with acute MDD. This open-label, nonrandomized controlled trial examined a MBCT cohort (N = 23) recruited to match the gender, age, and depression severity of a depressed control group (N = 20) that completed 8 weeks of monotherapy with the antidepressant sertraline. The 17-item clinician-rated Hamilton Depression Severity Rating Scale (HAMD-17) was the primary outcome measure of depression to assess overall change after 8 weeks and rates of response and remission. The 16-item Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR16) was the secondary outcome measure to further assess depression severity. Both cohorts were demographically similar and showed significant improvement in depression ratings. No difference was found in the degree of change in HAMD-17 scores (t(34) = 1.42, p = 0.165) between groups. Secondary analysis showed statistically significant differences in mean scores of the QIDS-SR16 (t(32) = 4.39, p < 0.0001), with the MBCT group showing greater mean improvement. This study was limited by the small sample size and non-randomized, non-blinded design. Preliminary findings suggest that an 8-week course of MBCT monotherapy may be effective in treating MDD and is a viable alternative to antidepressant medication. Greater changes in the self-rated QIDS-SR16 for the MBCT cohort raise the possibility that patients derive additional subjective benefit from enhanced self-efficacy skills.


Major depressive disorder Mindfulness Meditation Cognitive therapy Antidepressants Sertraline 


  1. Arch, J. J., & Craske, M. G. (2006). Mechanisms of mindfulness: emotion regulation following a focused breathing induction. Behaviour Research and Therapy, 44(12), 1849–1858. doi: 10.1016/j.brat.2005.12.007.CrossRefPubMedGoogle Scholar
  2. Avery, D., & Silverman, J. (1984). Psychomotor retardation and agitation in depression. Relationship to age, sex, and response to treatment. Journal of Affective Disorders, 7(1), 67–76.CrossRefPubMedGoogle Scholar
  3. Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13(1), 27–45. doi: 10.1177/1073191105283504.CrossRefPubMedGoogle Scholar
  4. Barnes, P. M., et al. (2004). Complementary and alternative medicine use among adults: United States. Advance Data, 343, 1–19.PubMedGoogle Scholar
  5. Barnhofer, T., Crane, C., Hargus, E., Amarasinghe, M., Winder, R., & Williams, J. M. (2009). Mindfulness-based cognitive therapy as a treatment for chronic depression: a preliminary study. Behaviour Research and Therapy, 47(5), 366–373. doi: 10.1016/j.brat.2009.01.019.CrossRefPubMedCentralPubMedGoogle Scholar
  6. Chiesa, A., Mandelli, L., & Serretti, A. (2012). Mindfulness-based cognitive therapy versus psycho-education for patients with major depression who did not achieve remission following antidepressant treatment: a preliminary analysis. Journal of Alternative and Complementary Medicine, 18(8), 756–760. doi: 10.1089/acm.2011.0407.CrossRefGoogle Scholar
  7. Cuijpers, P., Reynolds, C. F., 3rd, Donker, T., Li, J., Andersson, G., & Beekman, A. (2012). Personalized treatment of adult depression: medication, psychotherapy, or both? A systematic review. Depression and Anxiety, 29(10), 855–864. doi: 10.1002/da.21985.CrossRefPubMedGoogle Scholar
  8. Dunlop, B. W., Thase, M. E., Wun, C. C., Fayyad, R., Guico-Pabia, C. J., Musgnung, J., et al. (2012). A meta-analysis of factors impacting detection of antidepressant efficacy in clinical trials: the importance of academic sites. Neuropsychopharmacology, 37(13), 2830–2836. doi: 10.1038/npp.2012.153 npp2012153.CrossRefPubMedCentralPubMedGoogle Scholar
  9. Eisendrath, S. J., Delucchi, K., Bitner, R., Fenimore, P., Smit, M., & McLane, M. (2008). Mindfulness-based cognitive therapy for treatment-resistant depression: a pilot study. Psychotherapy and Psychosomatics, 77(5), 319–320. doi: 10.1159/000142525.CrossRefPubMedGoogle Scholar
  10. Eisendrath, S., Chartier, M., & McLane, M. (2011). Adapting mindfulness-based cognitive therapy for treatment-resistant depression: a clinical case study. Cognitive Behavior Practice, 18(3), 362–370. doi: 10.1016/j.cbpra.2010.05.004.CrossRefGoogle Scholar
  11. Finucane, A., & Mercer, S. W. (2006). An exploratory mixed methods study of the acceptability and effectiveness of mindfulness-based cognitive therapy for patients with active depression and anxiety in primary care. BMC Psychiatry, 6, 14. doi: 10.1186/1471-244X-6-14.CrossRefPubMedCentralPubMedGoogle Scholar
  12. First, M. B., Spitzer, Robert L, Gibbon Miriam, and Williams, Janet B.W. (2002). Structured clinical interview for DSM-IV-TR Axis I disorders, research version, Patient Edition. (SCID-I/P). Biometrics Research, New York State Psychiatric Institute, NovemberGoogle Scholar
  13. Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189–198.CrossRefPubMedGoogle Scholar
  14. Fresco, D. M., Moore, M. T., van Dulmen, M. H., Segal, Z. V., Ma, S. H., Teasdale, J. D., et al. (2007). Initial psychometric properties of the experiences questionnaire: validation of a self-report measure of decentering. Behaviour Therapy, 38(3), 234–246. doi: 10.1016/j.beth.2006.08.003.CrossRefGoogle Scholar
  15. Glue, P., Donovan, M. R., Kolluri, S., & Emir, B. (2010). Meta-analysis of relapse prevention antidepressant trials in depressive disorders. The Australian and New Zealand Journal of Psychiatry, 44(8), 697–705. doi: 10.3109/00048671003705441.CrossRefPubMedGoogle Scholar
  16. Godfrin, K. A., & van Heeringen, C. (2010). The effects of mindfulness-based cognitive therapy on recurrence of depressive episodes, mental health and quality of life: a randomized controlled study. Behaviour Research and Therapy, 48(8), 738–746. doi: 10.1016/j.brat.2010.04.006.CrossRefPubMedGoogle Scholar
  17. Hamidian, S., Omidi, A., Mousavinasab, S. M., & Naziri, G. (2013). Comparison of the effect of mindfulness-based cognitive therapy accompanied by pharmacotherapy with pharmacotherapy alone in treating dysthymic patients. Iran Red Crescent Medical Journal, 15(3), 239–244. doi: 10.5812/ircmj.8024.Google Scholar
  18. Hamilton, M. (1967). Development of a rating scale for primary depressive illness. British Journal of Social & Clinical Psychology, 6(4), 278–296.CrossRefGoogle Scholar
  19. Kenny, M. A., & Williams, J. M. (2007). Treatment-resistant depressed patients show a good response to mindfulness-based cognitive therapy. Behaviour Research and Therapy, 45(3), 617–625. doi: 10.1016/j.brat.2006.04.008.CrossRefPubMedCentralPubMedGoogle Scholar
  20. Kingston, J., Chadwick, P., Meron, D., & Skinner, T. C. (2007). A pilot randomized control trial investigating the effect of mindfulness practice on pain tolerance, psychological well-being, and physiological activity. Journal of Psychosomatic Research, 62(3), 297–300. doi: 10.1016/j.jpsychores.2006.10.007.CrossRefPubMedGoogle Scholar
  21. Koolschijn, P. C., van Haren, N. E., Lensvelt-Mulders, G. J., Hulshoff Pol, H. E., & Kahn, R. S. (2009). Brain volume abnormalities in major depressive disorder: a meta-analysis of magnetic resonance imaging studies. Human Brain Mapping, 30(11), 3719–3735. doi: 10.1002/hbm.20801.CrossRefPubMedGoogle Scholar
  22. Kuyken, W., Byford, S., Taylor, R. S., Watkins, E., Holden, E., White, K., et al. (2008). Mindfulness-based cognitive therapy to prevent relapse in recurrent depression. Journal of Consulting and Clinical Psychology, 76(6), 966–978.CrossRefPubMedGoogle Scholar
  23. Kuyken, W., Byford, S., Byng, R., Dalgleish, T., Lewis, G., Taylor, R., et al. (2010a). Study protocol for a randomized controlled trial comparing mindfulness-based cognitive therapy with maintenance anti-depressant treatment in the prevention of depressive relapse/recurrence: the PREVENT trial. Trials, 11, 99. doi: 10.1186/1745-6215-11-99.CrossRefPubMedCentralPubMedGoogle Scholar
  24. Kuyken, W., Watkins, E., Holden, E., White, K., Taylor, R. S., Byford, S., et al. (2010b). How does mindfulness-based cognitive therapy work? Behaviour Research and Therapy, 48(11), 1105–1112. doi: 10.1016/j.brat.2010.08.003.CrossRefPubMedGoogle Scholar
  25. Ma, S. H., & Teasdale, J. D. (2004). Mindfulness-based cognitive therapy for depression: replication and exploration of differential relapse prevention effects. Journal of Consulting and Clinical Psychology, 72(1), 31–40.CrossRefPubMedGoogle Scholar
  26. MacKinnon, D. P. (2008). Introduction to statistical mediation analysis. Ney York: Taylor & Francis Group.Google Scholar
  27. Manicavasgar, V., Parker, G., & Perich, T. (2011). Mindfulness-based cognitive therapy vs cognitive behaviour therapy as a treatment for non-melancholic depression. Journal of Affective Disorders, 130(1–2), 138–144. doi: 10.1016/j.jad.2010.09.027.CrossRefPubMedGoogle Scholar
  28. Mauri, M. C., Laini, V., Cerveri, G., Scalvini, M. E., Volonteri, L. S., Regispani, F., et al. (2002). Clinical outcome and tolerability of sertraline in major depression: a study with plasma levels. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 26(3), 597–601.CrossRefGoogle Scholar
  29. Murray, C. J., & Lopez, A. D. (1996). Evidence-based health policy–lessons from the global burden of disease study. Science, 274(5288), 740–743.CrossRefPubMedGoogle Scholar
  30. Neff, K. D. (2009). The role of self-compassion in development: a healthier way to relate to oneself. Human Development, 52(4), 211–214.CrossRefPubMedCentralPubMedGoogle Scholar
  31. Nolen-Hoeksema, S., & Morrow, J. (1991). A prospective study of depression and posttraumatic stress symptoms after a natural disaster: the 1989 Loma Prieta Earthquake. Journal of Personal and Social Psychology, 61(1), 115–121.CrossRefGoogle Scholar
  32. Nolen-Hoeksema, S., Morrow, J., & Fredrickson, B. L. (1993). Response styles and the duration of episodes of depressed mood. Journal of Abnormal Psychology, 102(1), 20–28.CrossRefPubMedGoogle Scholar
  33. Omidi, A., Mohammadkhani, P., Mohammadi, A., & Zargar, F. (2013). Comparing mindfulness based cognitive therapy and traditional cognitive behavior therapy with treatments as usual on reduction of major depressive disorder symptoms. Iran Red Crescent Medical Journal, 15(2), 142–146. doi: 10.5812/ircmj.8018.CrossRefGoogle Scholar
  34. Rawdin, B. S., Mellon, S. H., Dhabhar, F. S., Epel, E. S., Puterman, E., Su, Y., et al. (2012). Dysregulated relationship of inflammation and oxidative stress in major depression. Brain, Behavior, and Immunity. doi: 10.1016/j.bbi.2012.11.011.PubMedCentralPubMedGoogle Scholar
  35. Rush, A. J., Trivedi, M. H., Ibrahim, H. M., Carmody, T. J., Arnow, B., Klein, D. N., et al. (2003). The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biological Psychiatry, 54(5), 573–583.CrossRefPubMedGoogle Scholar
  36. Rush, A. J., Trivedi, M. H., Wisniewski, S. R., Stewart, J. W., Nierenberg, A. A., Thase, M. E., et al. (2006). Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression. New England Journal of Medicine, 354(12), 1231–1242. doi: 10.1056/NEJMoa052963.CrossRefPubMedGoogle Scholar
  37. Segal, Z., Williams, J. M., & Teasdale, J. (2002). Mindfulness -based cognitive therapy for depression. New York: The Guilford press.Google Scholar
  38. Segal, Z. V., Bieling, P., Young, T., MacQueen, G., Cooke, R., Martin, L., et al. (2010). Antidepressant monotherapy vs sequential pharmacotherapy and mindfulness-based cognitive therapy, or placebo, for relapse prophylaxis in recurrent depression. Archives of General Psychiatry, 67(12), 1256–1264. doi: 10.1001/archgenpsychiatry.2010.168.CrossRefPubMedCentralPubMedGoogle Scholar
  39. Shawyer, F., Meadows, G. N., Judd, F., Martin, P. R., Segal, Z., & Piterman, L. (2012). The DARE study of relapse prevention in depression: design for a phase 1/2 translational randomised controlled trial involving mindfulness-based cognitive therapy and supported self monitoring. BMC Psychiatry, 12, 3. doi: 10.1186/1471-244X-12-3.CrossRefPubMedCentralPubMedGoogle Scholar
  40. Teasdale, J. D., Segal, Z. V., Williams, J. M., Ridgeway, V. A., Soulsby, J. M., & Lau, M. A. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 68(4), 615–623.CrossRefPubMedGoogle Scholar
  41. Thase, M. E., Haight, B. R., Richard, N., Rockett, C. B., Mitton, M., Modell, J. G., et al. (2005). Remission rates following antidepressant therapy with bupropion or selective serotonin reuptake inhibitors: a meta-analysis of original data from 7 randomized controlled trials. Journal of Clinical Psychiatry, 66(8), 974–981.CrossRefPubMedGoogle Scholar
  42. Van Dam, N. T., Sheppard, S. C., Forsyth, J. P., & Earleywine, M. (2010). Self-compassion is a better predictor than mindfulness of symptom severity and quality of life in mixed anxiety and depression. Journal of Anxiety Disorders. doi: 10.1016/j.janxdis.2010.08.011.PubMedGoogle Scholar
  43. WHO (2001) Burden of mental and behavioral disorders. Geneva: WHO.Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Stuart J. Eisendrath
    • 1
    Email author
  • Erin Gillung
    • 1
  • Kevin Delucchi
    • 1
  • Daniel H. Mathalon
    • 2
  • Tony T. Yang
    • 1
  • Derek D. Satre
    • 1
    • 3
  • Rebecca Rosser
    • 1
  • Walter E. B. Sipe
    • 1
  • Owen M. Wolkowitz
    • 1
  1. 1.Department of PsychiatryUniversity of California-San FranciscoSan FranciscoUSA
  2. 2.San Francisco VA Medical CenterSan FranciscoUSA
  3. 3.Division of ResearchKaiser PermanenteOaklandUSA

Personalised recommendations